See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/265427007

Empathy: It's Relationship to Prenatal Attachment and Previous Parenting

Experience

Article

CITATIONS READS

2 98

3 authors, including:

Anona Zimerman
Surrey Place Centre
6 PUBLICATIONS   45 CITATIONS   

SEE PROFILE

All content following this page was uploaded by Anona Zimerman on 12 June 2016.

The user has requested enhancement of the downloaded file.

Int. J. Prenatal and Perinatal Psychology and Medicine Vol. 20 (2008) No. 1/2, pp. 29–41

Empathy: It’s Relationship to Prenatal Attachment

and Previous Parenting Experience
Anona Zimerman and Helen McK. Doan

Abstract: According to Ainsworth (1985), the key to promoting a positive attachment lies
in the mother’s ability to sensitively interpret and respond to her child’s cues. Sensitiv-
ity of the mother has been strongly associated with the child’s subsequent attachment to
her child (Pederson, Gleason, Moran & Bento, 1998). Although directly it is sensitivity
that Ainsworth and her contemporaries discuss, empathic ability has been implicated as
an important attribute leading to sensitive responding (Quinn, 1991). The purpose of the
present paper is to examine the relationship between empathy and prenatal attachment
and to determine if that relationship would differ depending on the previous parenting
experience of the pregnant woman. Comparisons were made between women expecting
their first child, women who are already mothers and expecting a subsequent child, and
pregnant women who have a previous child with Down syndrome.
Zusammenfassung: Nach Ainsworth (1985) liegt der Schlüssel für eine positive Bindungs-
beziehung in der Fähigkeit der Mutter, die Bedürfnisse des Kindes sensibel zu verste-
hen und entsprechend auf sie zu reagieren. Die Sensibilität der Mutter ist eng verknüpft
mit der nach folgenden Bindung (Pederson, Gleason, Moran & Bento, 1998). Obwohl
Ainsworth und ihre Mitarbeiter direkt immer nur die Sensibilität diskutieren, ist die
Fähigkeit zur Einfühlung dabei ein wichtiger Bestandteil der Fähigkeit zu für ein sensibles
Reagieren (Quinn, 1991). Das Ziel dieses Beitrages besteht darin, den Bezug zwischen
Einfühlung und pränataler Bindungsbeziehung zu überprüfen und zu erfassen, inwieweit
sich diese Bindungsbeziehung danach unterscheidet, welche früheren Elternerfahrungen
die Schwangere gemacht hat. Es wurden Vergleiche zwischen drei Gruppen von Müttern
gemacht: Mütter, die ihr erstes Kind erwarteten, Mütter, die bereits Kinder hatten und
Schwangeren, die ein früheres Kind mit Downsyndrom hatten.
Keywords: Empathy, prenatal attachment, parenting experience

The Empathy Construct

In the literature, the nature of empathy as a construct has been discussed in terms
of four issues: The focus for some theorists is whether empathy is a personality
trait or is a situational-specific cognitive affective state (e.g., Duan & Hill, 1996).
Other theorists debate whether the nature of the empathy is primarily affective
(i.e., responding to the emotions of others) or cognitive (involving an intellectual
understanding of the experiences of others, or contains both affective and cogni-
tive components (e.g., Duan & Hill, 1996). A third issue, relating to the empathy, is
whether self-oriented reactions to the distress of others can be considered a form
of empathy, or empathy is limited to other-oriented reactions (e.g., Perez-Albeniz
30 Anona Zimerman and Helen McK. Doan

& de Paul, 2003). Finally, the complexity of empathy at a behavioural level has
been noted (e.g., Brems, 2001).
Definitions of empathy in the literature illustrate some of the different ap-
proaches to the construct. Some emphasize the emotional aspect by defining em-
pathy as “a vicarious emotional response to the perceived emotional experiences
of others” (Mehrabian & Epstein, 1972). Others have underscored the cognitive
aspect, and said that empathy is “an attempt by one self-aware self to comprehend
unjudgmentally the positive and negative experiences of another self” (Wispe,
1986, p. 318).
Davis (1994), assumed a model of empathy as a stable trait consisting of both
cognitive and emotional components. He stated “Empathy is broadly defined
as a set of constructs having to do with the responses of one individual to the
experiences of another” (p. 12). He strongly advised the consideration of a multi-
dimensional approach to empathy. According to Davis, and many other theorists,
the study of empathy is ill-served by limiting it to either the affective or the cogni-
tive realm, and is best served by both perspectives, providing a holistic and more
accurate picture. (Bennett, 1995; Davis, 1983a & b; 1994).

Measuring Empathy
Many scales have been developed to measure the different components of empa-
thy (Davis, 1994), e.g., Hogan’s Empathy Scale (EM; 1969), a measure of cognitive
empathy; the Questionnaire Measure of Emotional Empathy (QMEE; Mehra-
bian & Epstein, 1972); and La Monica’s (1981) Empathy Construct Rating Scale
(ECRS) a multidimensional measure.
Davis’ Interpersonal Reactivity Index (IRI; 1983a & b), is unique in its ap-
proach, in that it can be used to measure both the cognitive and emotional do-
mains of empathy, as well as the self and other oriented component. It provides a
multidimensional perspective of empathy encompassing both cognitive and emo-
tional components (Davis, 1983a & b; Hatcher, Nadeau, Walsh, Reynolds, Galea,
and Marz, 1994).

Parenting and Empathy

Although few studies have examined directly the relationship between empathy
and attachment (Quinn, 1991), the ability to be empathic has been consistently
implicated in the literature on parenting (Belsky, 1984; Perez-Albeniz & de Paul,
2003; Quinn, 1991). Also, several recent studies have examined the relationship
between empathy and behaviours related to attachment, e.g., dimensions of at-
tachment interpersonal relationships and style (Brems, 2001; Joireman, Needham
& Cummings, 2001); adult attachment (Britton & Fuendeling, 2005); parenting
strategies (Brems & Sohl, 1995); attachment style (Wayment, 2006) and friendship
quality (Soenens, Duriez, Vansteenkiste, & Goossens, 2007). In addition, theo-
ries of parenting repeatedly emphasize the importance of correctly interpreting
a child’s cues and having to be sensitive to a child’s needs. The desired parenting
behaviour is sensitive responsiveness, while empathic ability to perceive and cor-
rectly interpret the child’s cues is the precursor, or pre-requisite, characteristic
Empathy and Prenatal Attachment 31

(Winnicott, 1965; Mahler, Pine, & Bergman, 1975). Hannush (2002), in his book
Becoming Good Parents, unhesitatingly highlights the importance of empathy, or
affective attunement, of the parents to the emotional development of children.
According to Hannush, “This kind of attunement validates the subjective experi-
ence of children. It affirms the rightness of their perceptions of themselves and
the world” (p. 36).
Quinn (1991) examined the attachment patterns of youngsters with Down syn-
drome and related them to their mothers’ empathic ability, as well as their per-
ceived social support. She asserted, that a child with special needs brings out
additional empathic resources in the parent due to the extra attention they com-
mand. Quinn (1991) found a significant positive correlation between mothers’
empathy and the dyadic attachment patterns.
More directly related to the topic of the present article, Doan, Zimerman, and
Howell (1997) and Doan, Howell, and Zimerman (1998) used the IRI to exam-
ine the relationship among empathy, fetal attachment (using the Maternal and
Paternal Fetal Attachment Scale, Cranley, 1981b), attitudes towards pregnancy
(using The Prenatal Self-Evaluation Questionnaire, Lederman, 1984), and sex-
role identification (The Bem Sex-Role Inventory, Bem, 1974), in a group of male
and female, non-parent, non-pregnant undergraduate students. In these studies,
undergraduate students, both male and female, who were not parents and not
expecting a child, had no difficulty imagining a pregnancy and were able to ex-
press their feelings about an imagined pregnancy. As well, the empathic concern
subscale was found to be significantly correlated with imagined fetal attachment
but negatively correlated to the measure of attitudes towards (an imagined) preg-
nancy, in both males and females. These findings lend support to the importance
of further study into the relationship between empathy and prenatal attachment
during pregnancy.

Prenatal attachment* and Its Measurement

Although there has been some consensus and
overlap in the literature, about the definition of prenatal attachment, there
have been differences in the focus of the definitions. For example, Cranley (1981)
emphasized the behaviours that represent “affiliation and interaction with their
unborn child” (Cranley, 1981a, p. 282). Muller (1993), on the other hand, stressed
“the unique, affectionate relationship that develops between a woman and her
fetus” (p. 201). Condon (1993) focused on “the emotional tie or bond, which nor-
mally develops between the pregnant woman and her unborn infant” (p. 359).
Finally, to represent the multidimensionality of the concept of prenatal attach-
ment, Doan and Zimerman’s (2002) definition included: “An abstract concept,
representing the affiliative relationship between a parent and a fetus, which is
potentially present before pregnancy, is related to cognitive and emotional abili-
ties to conceptualize another human being, and develops in an ecological system”
(p. 185).

* Prenatal attachment has also been termed, Antenatal attachment, Fetal attachment,
maternal or paternal fetal attachment.
32 Anona Zimerman and Helen McK. Doan

While there are similarities in the definitions, they each emphasize specific
aspects of the relationship a parent has with their fetus. Cranley referred to affili-
ation, but stressed behaviour in her definition, while Muller described the relation-
ship in terms of its affectionate flavour, the uniqueness of it, and its developmental
essence. Condon, as well, emphasized the affectionate aspect of the relationship,
but he also made reference to the normative and developmental nature of pre-
natal attachment. The Doan and Zimerman definition focused not only on the
affectionate nature of the relationship and its developmental nature, but also
on the parents’ characteristics, and the context of the relationship. In addition,
the first three definitions (Cranley’s, Muller’s and Condon’s) are closely related
to the measures they each developed (i.e., Cranley’s Maternal Fetal Attachment
Scale (MFAS), 1981; Condon’s Antenatal Attachment Scale, 1993; and Muller’s
Prenatal Attachment Inventory, 1993).

A Study of the Relationship Between Empathy

and Maternal-fetal Attachment
Based on previous research that demonstrated a significant correlation between
parental empathy and attachment (Quinn, 1991), and imagined prenatal attach-
ment and empathy (Doan, Zimerman & Howell, 1997; Doan, Howell & Zimer-
man, 1998), the purpose of the present study was to examine the relationship
between empathy and prenatal attachment. It was of interest in the present study
to further examine if the relationship between empathy and prenatal attachment
would be different based on parenting experience, e.g. women expecting their
first child, women who are already mothers and expecting a subsequent child,
and, pregnant mothers of a child with Down syndrome.
The questions guiding the present study were:
1. Do pregnant women who are already mothers have higher empathy scores
than women expecting their first child, implying that empathy was learned or
enhanced, through parenting?
2. Do pregnant women who are the mothers of a child with Down syndrome have
higher levels of measured empathy than women expecting their first child, or
mothers of a typically developing child, implying that mothering a child with
developmental disabilities brings out and enhances the empathic abilities of
the mother even more than parenting a typically developing child?
3. Do pregnant women who have higher empathic abilities also have higher prena-
tal attachment, implying that empathic abilities contribute to the affectionate
relationship one has with her preborn child?

Participants
The participants consisted of 171 women expecting their first child; 50 women who
were already mothers and expecting a subsequent child, and 15 pregnant moth-
ers who had a child with Down syndrome and were now expecting another child.
The mothers in all groups were similar in the demographic variables of education
and income, but the group of women expecting their first child was significantly
younger than the women who were already mothers.
Empathy and Prenatal Attachment 33

Instruments
The instruments used were the Davis’ measure of empathy (i.e., the Interper-
sonal Reactivity Index) and Condon’s (1993) Maternal Antenatal Attachment
Scale (MAAS).
The Interpersonal Reactivity Index (IRI) is a well-validated instrument com-
prised of four subscales. As their respective names imply, they reflect the follow-
ing: Perspective taking scale (PT), Fantasy scale (FS), Empathic Concern scale
(EC), and, Personal Distress scale (PD). The PT subscale is described by Davis as
“the tendency to spontaneously adopt the psychological point of view of others”
(Davis, 1983b, pp. 113–114). An item exemplifying this subscale is “I sometimes try
to understand my friends better by imagining how things look from their perspec-
tive”. The FS subscale is described as the “respondents’ tendencies to transpose
themselves into the feelings and actions of fictitious characters in books, movies,
and plays” (Davis, 1983b, p. 114). An example of an item from the FS is “I really
get involved with the feelings of characters in a novel”. The EC scale describes
feelings and concerns which are “other oriented” (p. 114). An example from this
subscale is “When I see someone being taken advantage of, I feel kind of pro-
tective towards them”. And the PD scale measures one’s own feelings of “anxiety
and unease in tense interpersonal situations” (p. 114). An example from the PD
subscale is “Being in intense emotional situations scares me”. The subscales are
considered to be as follows: EC and PD are emotionally based, while the PT and
FS are cognitively based.
The MAAS is comprised of a global prenatal attachment score and two sub-
scales – the Quality of attachment, and the Frequency or intensity of attach-
ment. The subscale Quality of attachment includes experiences such as close-
ness/distance, tenderness/ irritation, positive/negative thoughts and feelings, as
well as representations of the fetus on a continuum from ‘real person’ to ‘living
thing’. An example of an item on the Quality subscale is “Over the past two weeks
my feelings about the baby inside me have been.” (responses ranging from (a)
very weak or non-existent, to (e) very strong).
Items measuring the frequency and/or the intensity of the preoccupation with
the fetus represent the subscale Frequency. It uses ratings of frequent/infrequent,
and strong/weak that do not refer to the ‘quality’ of the feelings, thoughts, or
behaviours in question. An example of an item on the Frequency scale is “Over
the past two weeks I have been preoccupied with the baby inside me.” (responses
ranging from (a) all of the time, to (e) never).

The Results
One-way analyses of variance were conducted to examine the group comparisons
on scores of empathy and attachment. These analyses revealed:
– no significant mean group differences on any of the empathy measures, i.e., the
empathy global score, and the four subscales.
– significant group differences on the Global attachment score (MAAS), and the
Frequency subscale (MAAS, F (2, 233) = 7.993, p < .001; FREQ. F (2,233) =
16.762, p < .001). Post-Hoc multiple comparisons, using the Bonferroni and
Least Square Difference test, revealed the group of pregnant women who were
34 Anona Zimerman and Helen McK. Doan

already mothers of a typically developing child or children, scored significantly

lower on both scores.
Significant correlations between the measures of empathy and attachment and
their subscales were found:
– For the groups of women expecting their first child (FT) and women who have
a typically developing child or children and are pregnant now (TS), the partic-
ipants who reported higher global empathy scores, also reported higher global
attachment scores and higher scores on the Frequency subscale of the attach-
ment scale (FT Moms: IRI & MAAS: r = .206, p > .01; IRI & Frequency: r =
.241, p > .01; TS Moms: IRI & MAAS: r = .320, p > .05; IRI & Frequency: r
= .425, p < .01).
– In all three groups, the higher the empathy subscale Perspective taking, the
higher the attachment subscale Frequency. A much larger correlation was ob-
served for the DS Moms group (DS Moms: r = .580, p < .05; FT Moms: r =
.150, p < .05; TS Moms: r = .285, p < .05).
– For the FT Moms, the empathy subscale Emphatic concern (Concern), was
significantly correlated with the global attachment score, as well as with both
attachment subscales (MAAS: r = .323, p < .01; Quality: r = .264, p < .01; and
Frequency: r = .292, p < .01); and for the DS Moms, with the global attachment
score as well as with the Quality subscale (MAAS: r = .568; p < .05; Quality: r
= .562; p < .05).
– For the TS Moms, no correlations were observed between the Empathic con-
cern subscale and any of the attachment scores.
– The empathy subscale Fantasy was significantly correlated with the attachment
subscale Frequency for the FT Moms and for the TS Moms, but not for the DS
Moms (FT Moms: r = .164, p < .05; TS Moms: r = .284, p < .05).
– Significant correlations were observed for the empathy subscale Personal dis-
tress (Distress) with the attachment subscale Frequency, for the two subsequent
groups (TS Moms: r = .489; p < .01; DS Moms: r = –.585, p < .05). For the
TS Moms, the correlation was positive and for the DS Moms, negative.
– The empathy subscale Distress was also negatively correlated with the global
attachment score, but only for the DS Moms group (r = –.597, p < .05).

Discussion
Group Differences in Empathy
There were no significant group differences on any of the global or subscales of
the empathy measure. Two explanations were entertained: the first that the expe-
rience of mothering, either a ‘typical’ child or a child with DS, does not render one
more or less empathic. And the second possibility is that the IRI is not a sensitive
enough instrument to differentiate parenting-related empathic traits. However,
for all groups, there were individual differences in the scores obtained on the IRI
and each of the four subscales. For example, on the overall score, the FT group
had a range of scores from 31–94; the TS group from 32–101; and the DS group
from 53–75 (possible range 0–112). Therefore, some women, particularly in the
Empathy and Prenatal Attachment 35

FT and TS groups, demonstrated low empathy scores. The implications, for those
with low scores, needs further investigation.

Group Differences in Prenatal Attachment

The result of a significantly lower Frequency score, for the TS mothers, came as
no surprise. As Condon (1993) noted, once a woman has to look after a child, she
might have less time in her subsequent pregnancy, to spend in prenatal attach-
ment mode. However, the reduced Frequency of time spent in prenatal attach-
ment mode, as demonstrated by the mothers of a typically developing child, was
not correlated with the Quality of her prenatal attachment, which they were for
the other two groups.
The variability of scores on all three of the prenatal attachment measures, i.e.,
MAAS, Quality and Frequency scores, was also apparent for each of the groups.
For example, on the MAAS measure, for the FT, TS, and DS groups respectively,
their scores ranged from 36–70; 33–68; and 42–66 (possible range 0–76). This vari-
ability of scores is consistent with previous research, e.g., Doan and Zimerman,
(2002) and suggests some of the women in all groups had relatively low attachment
scores.

Empathy and Prenatal Attachment

For the FT and TS groups, there was a significant relationship between the mea-
sure of empathy and prenatal attachment, i.e., the higher the level of empathy,
the higher the scores on both the Global and Frequency scores of the attachment
measure. The correlations were not significant for the DS group. To understand
the lack of correlation with the DS group, the subscales of the empathy and at-
tachment measures were examined.
The Perspective taking subscale of the empathy measure and the Frequency
subscale of the prenatal attachment scale were significantly positively correlated
in all three groups. These correlations were highest for the DS Moms. The Per-
spective taking subscale is said to be most representative of cognitive empathy
(Carey, Fox and Spraggins, 1988; Davis, 1983b). The PT empathy subscale is com-
prised of statements that reflect an understanding of the experience of others.
This is the subscale most typical of “putting oneself in another’s shoes”.
Although not previously stated in the literature, the Frequency subscale can be
seen as the more cognitively based domain of the two attachment subscales. The
Frequency subscale represents an awareness of the amount of time and intensity,
of engaging in attachment mode. The positive correlation between the Frequency
prenatal attachment subscale and PT empathy subscale highlights the connection
between cognitive empathy and the conscious awareness of one’s fetus. Inter-
estingly, despite the small group size, the DS Moms’ correlation was significant.
Possibly, mothers of a child with DS, who had to respond to the special needs
of a child who may not be emitting cues at the same rate or intensity as a typi-
cally developing child (Ganiban, Barnett, & Cicchetti, 2000), have sharply tuned
their empathic skills to respond to specific areas. In particular, it appears that the
mother of a child with DS who understands the general experience of others, also
spends more time thinking about her fetus and his or her experience.
36 Anona Zimerman and Helen McK. Doan

The Empathic concern subscale of the empathy measure and the Quality sub-
scale of the attachment scale were significantly correlated for the FT Moms and
DS Moms groups. For the FT Moms, Empathic concern was also significantly
correlated with the Frequency attachment score. Curiously, for the TS Moms,
there was no significant correlation between these two variables. The Empathic
concern subscale is said to be the closest one to representing the emotional aspect
of empathy (Davis, 1983b). The Quality subscale represents the affective aspect
of prenatal attachment (Condon, 1993). The only significant correlation with the
Quality attachment measure, was the Empathic concern subscale. The Frequency
subscale seems generally to be more sensitive to variations in the different sub-
scales of the empathy measure and to the different groups of mothers-to-be.
The relationship between the subscales of empathic concern and quality of
attachment would highlight the relevance to parenting, of the ability to feel for
the experience of another being who is in a vulnerable position. The more the FT
Mom cares and feels for the less fortunate and/or vulnerable (the EC subscale), the
stronger the specific affection, and affiliative feelings towards her preborn child.
Women expecting their first child may have heightened associations between two
affective states – the one, representing general emotional empathy, and the other,
the specific feelings towards the preborn child. For mothers of a child with DS,
meeting the needs of their child (with DS) may be highly associated with their
affection and protective feelings towards that child. Possibly, this extends to their
subsequent child even before its born, as can be seen in the results of the present
study.
For the TS group, none of the subscales of the empathy measure were corre-
lated with the Quality of their attachment. This finding sets the TS Moms group
apart from the other two groups. Interpreting this result presents a challenge.
However, other cross-sectional designs with special attention to variables such as
empathy, sensitivity, attachment, etc., would confirm or refute the present find-
ings, and further elucidate the connection between emotional empathy and the
quality of prenatal attachment.
The interesting result of the DS Moms’ moderately high correlation (r = .562)
between Empathic concern and Quality of prenatal attachment, raises the pos-
sibility of a process of parenting, which is different for a parent of a child with
a developmental disability. In their theory of Transformed Parenting, Seideman
and Kleine (1995) describe the stages of adaptation, coping, and functioning of
parents of children with a developmental disability, such as Down syndrome. They
posit in one of the stages, that parents become advocates for their own child and
at times, also for others in a similar situation. They become in a way “super par-
ents” (p. 43). They strive to become experts on their child’s condition and needs,
and seek information to that end. In the present study the mothers of child with
DS have proceeded to become pregnant subsequently. Possibly, if the theory of
Transformed Parenting is considered, the need to advocate on behalf of a their
vulnerable child, who does not necessarily express his or her needs in an easily
interpretable way, highlights the mother’s empathic characteristics as they relate
to the commitment they feel towards their child. Possibly, the results of this study
indicate that the connection between a mother’s empathy, and her commitment
Empathy and Prenatal Attachment 37

to her child with DS, is generalized to her next fetus, as reflected in the Quality
subscale of prenatal attachment.
A surprising finding was the group difference in the correlations between the
Personal distress (PD) subscale of empathy, and the Frequency subscale of at-
tachment. In essence, for FT Moms, the PD subscale was not correlated with any
MAAS subscale. However, for the TS Moms, there was a moderately high signif-
icant positive correlation, while for the DS Moms, there was a moderately high
significant negative correlation.
Several studies have mentioned that the PD, one of the two emotional sub-
scales of the IRI, is contradictory to the traditional intention of emotional em-
pathy, which is primarily feeling what others may be experiencing emotionally
(Lawrence, Shaw, Baker, Baron-Cohen, & David, 2004; Perez-Albeniz & de Paul,
2003). Rather, the PD subscale measures “the individual’s own fear, feelings of
apprehension and discomfort at witnessing the negative experiences of others”
(Davis, 1980, p. 4). Some researchers describe the Personal distress subscale as
“not considered as a genuine form of empathy” (Batson, Fultz, & Schoenrade,
1987; Perez-Albeniz & de Paul, 2003). In the present study, there seem to be three
patterns of associations between the PD and the Frequency subscale of prenatal
attachment: 1. Women whose self-oriented reactions to others’ negative experi-
ences, are not related to their prenatal attachment; 2. Women who, when they
are particularly sensitive to their own reactions of distress at others’ negative ex-
periences, are likely to engage in prenatal attachment mode more frequently and
with higher intensity; and 3. Women who, when they are likely to experience self-
oriented reactions to the distress of others, tend to engage in prenatal attachment
mode much less frequently, and with less intensity. However, in the present study,
these three patterns of association are also related to the women’s previous par-
enting experience. The first pattern, consisting of no associations between the PD
empathy subscale and Frequency of prenatal attachment, is found in the group
FT Moms; the second pattern, where the PD empathy subscale is positively corre-
lated with the MAAS Frequency subscale is occurring in the TS Moms’ group; and
finally, the pattern where there is a negative correlation between the PD empathy
subscale and the Frequency MAAS subscale is found in the DS Moms’ group.
While for women who are mothers of a child with DS, a high score on the Fre-
quency subscale of prenatal attachment is incompatible with the tendency to think
first about themselves at the distress of others (a high score on the PD subscale
of empathy), for mothers of a typically developing child, it is the opposite. One
possible explanation may be that mothers of a child with DS, are likely to experi-
ence more intense caregiving, and perhaps more worrying about their child than
if the child had no special needs (Atkinson, Scott, Chisholm, Blackwell, Dickens,
Tam, & Goldberg, 1995; Cahil, & Masters Glidden, 1996). It may become clear
to mothers of a child with DS, that when their initial reaction to the distress of
others is a self-oriented one, they are not as effective in dealing with the issues (in-
volving the child with DS) that they must take care of. The mother of a child who
is typically developing has not faced having to deal with the additional demands
of ensuring the physical and mental development of a child with a developmental
disability. The TS Mom, whose child has less intense and urgent needs, may have
had less opportunity to associate self-oriented feelings, with insufficient care. In
38 Anona Zimerman and Helen McK. Doan

fact, as the results of this study show for the mother of a typically developing
child, the self-oriented reactions at the distress of others are positively related
to the frequency of her thoughts and behaviours she has developed towards the
subsequent baby she is presently carrying.
The conceptual difference between self- vs. other oriented empathy poses at
least two questions in the area of parenting. First, what are the individual differ-
ences on these two conceptually different aspects of empathy, and how do they
correspond to parenting status (first timers, parents of two or more children, par-
ents of a child with disabilities, etc). The second question is what is the relationship
of these two orientations of empathy with actual helping, or caregiving, behaviour.
The results, of group differences in the correlational pattern with prenatal attach-
ment, suggest that this is an area well worth investigating.

Conclusions and Future Directions

The results of the present study suggest that there is a relationship between em-
pathy and prenatal attachment. Further longitudinal research could help to clar-
ify not only the relationship of empathy and prenatal attachment but also their
implications to the future relationship of the mother and her child. As well, the
importance of understanding how different levels of empathy and prenatal attach-
ment actually impact on behaviours during pregnancy must be underscored. For
example, previous research has reported that women who engaged in behaviours
that endangered the fetus (termed fetal abuse) were also found to have low levels
of, or lack of, prenatal attachment (Pollock & Percy, 1999).
The variability of scores both within and between groups of pregnant women,
suggest that the women with low empathy and/or low prenatal attachment need
to be identified and programmes developed to augment their level of prenatal
attachment. The differences found among the three groups of pregnant women,
in the present study, demonstrate a need for health workers to clearly identify the
needs of each group and suggest that researchers should separate out the groups
in their research.
It is not possible from correlational data to know whether empathy is a trait, and
an antecedent condition for the development of prenatal attachment or whether
the parenting experience becomes a specific situation that elicits empathic re-
sponses. However, even if empathy is a trait, and would, therefore, be difficult to
teach, it would not be impossible to teach behaviours, which indicate sensitivity
and understanding of others. As well, active listening can also be taught.
The present study has illustrated that it is important to understand situational
factors, such as, whether the woman is expecting her first child, or is already a
mother of a ‘typical’ child, or, whether she is the mother of a child with a disabil-
ity, when studying psychological processes during pregnancy. As well, this study
illuminated the connection between a personality aspect – namely empathy, and
a specific area of parenting – that of the prenatal child.
Empathy and Prenatal Attachment 39

References
Atkinson L, Scott B, Chisholm V, Blackwell J, Dickens S, Tam F, Goldberg S (1995) Cogni-
tive coping, affective distress, and maternal sensitivity: Mothers of children with Down
syndrome. Developmental Psychology, 31, 668–676.
Ainsworth MDS (1985) Patterns of mother-infant attachment: Antecedents and effects on
development. Bulletin of New York Academy of Medicine, 61, 771–790.
Batson CD, Fultz J, Schoerade PA (1987) Distress and empathy: two qualitatively distinct
vicarious emotions with different motivational consequences. Journal of Personality, 55,
19–39.
Belsky J (1984) The determinants of parenting: A process model. Child Development, 55,
83–96.
Bem SL (1974) The measurement of psychological androgyny. Journal of Consulting and
Clinical Psychology, 42, 155–162.
Bennett JA (1995) Methodological notes on empathy: further considerations. Advances in
Nursing Science, 18, 36–50.
Brems C (2001) Dimensionality of empathy and its correlates. The Journal of Psychology,
123, 329–337.
Brems C, Sohl MA (1995) The role of empathy in parenting strategy choices. Family Re-
lations, 44, 189–194.
Britton PC, Fuendleling JM (2005) The relations among varieties of adult attachment and
the components of empathy. The Journal of Social Psychology, 145, 519–530.
Cahill BM, Masters Glidden L (1996) Influence of child diagnosis on family and parental
functioning down syndrome versus other disabilities. American Journal on Mental Re-
tardation, 101, 149–160.
Carey JC, Fox EA, Spraggins EF (1988) Replication of structure findings regarding the
interpersonal reactivity index. Measurement and Evaluation in Counseling and Devel-
opment, 21, 102–105.
Condon JT (1993) The assessment of antenatal emotional attachment: Development of a
questionnaire instrument. British Journal of Medical Psychology, 66, 167–183.
Cranley MS (1981a) Development of a tool for the measurement of maternal attachment
during pregnancy. Nursing Research, 30, 281–284.
Cranley MS (1981b) Roots of attachment: The relationship of parents with their unborn.
Birth Defects: Original Article Series, 6, 59–83.
Davis MH (1980) A multidimensional approach to individual differences in empathy. JSAS
Catalogue of Selected Documents in Psychology, 10, 85.
Davis MH, Luce C, Fraus SJ (1994) The heritability of characteristics associated with dis-
positional empathy. Journal of Personality, 62, 369–391.
Davis MH (1983a) The effects of dispositional empathy on emotional reactions and help-
ing: A multidimensional approach. Journal of Personality, 51, 167–184.
Davis MH (1983b) Measuring individual differences in empathy: Evidence for a multidi-
mensional approach. Journal of Personality and Social Psychology, 44, 113–126.
Davis MH (1983c) Empathic concern and the muscular dystrophy telethon: Empathy as a
multidimensional construct. Personality and Social Psychology Bulletin, 9, 223–229.
Davis MH (1994) Empathy: A social psychological approach. Dubuque, Iowa: Brown &
Benchmark.
Doan H McK, Zimerman A (2002) Prenatal attachment: where do we go from here? In-
ternational Journal of Prenatal and Perinatal Psychology and Medicine, 14, 177–188.
Doan H McK, Zimerman A, Howell S (1997) Antecedents to parenthood: Preliminary
results. Poster session presented at meeting of the Canadian Psychological Association,
Toronto, Ontario.
40 Anona Zimerman and Helen McK. Doan

Doan H McK, Zimerman A, Howell S (1998) Antecedents to parenthood. Poster ses-

sion presented at the meeting of the Canadian Psychological Association, Edmonton,
Alberta.
Doan H McK, Zimerman A, Howell S (1998) Parental-fetal attachment: An investiga-
tion of personality correlates. Poster session presented at the meeting of the Canadian
Psychological Association, Edmonton, Alberta.
Duan C, Hill CE (1996) The current state of empathy research. Journal of Counseling
Psychology, 43, 261–274.
Ganiban J, Barnett D, Cicchetti D (2000) Negative reactivity and attachment: Down syn-
drome’s contribution to the attachment-temperament debate. Development and Psy-
chopathology, 12, 1–12.
Hannush MJ (2002) Becoming Good Parents: an Existential Journey. State University of
New York Press: Albany, New York.
Hatcher SL, Nadeau MS, Walsh LK, Reynolds M, Galea J, Marz K (1994) The teaching
of empathy for high school and college students: Testing Rogerian methods with the
interpersonal reactivity index. Adolescence, 29, 961–974.
Joireman JA, Needham TL, Cummings AL (2001) Relationships between dimensions of
attachment and empathy. North American Journal of Psychology, 3, 63–80.
LaMonica EL (1981) Construct validity of an empathy instrument. Research in Nursing
and Health, 4, 384–400.
Lawrence EJ, Shaw P, Baker D, Baron-Cohen S, David AS (2004) Measuring empathy:
reliability and validity of the empathy quotient. Psychological Medicine, 34, 911–924.
Lederman RP (1984) Psychological adaptation in pregnancy: Assessment of seven dimen-
sions of maternal development. Englewood Cliff, NJ: Prentice Hall.
Mahler M, Pine F, Bergman A (1975) The psychological birth of the human infant. New
York: Basic Books.
Mehrabian A, Epstein N (1972) A measure of emotional empathy. Journal of Personality,
40, 525–543.
Muller ME (1993) Development of the prenatal attachment inventory. Western Journal of
Nursing Research, 15, 199–215.
Pederson DR, Gleason KE, Moran G, Bento S (1998) Maternal attachment represen-
tations, maternal sensitivity, and the infant-mother attachment relationship. Develop-
mental Psychology, 34, 925–933.
Perez-Albeniz A, de Paul J (2003) Dispositional empathy in high- and low-risk parents for
child physical abuse. Child Abuse and Neglect, 27, 769–780.
Pollock PH, Percy A (1999) Maternal antenatal attachment style and potential fetal abuse.
Child Abuse and Neglect, 23, 1345–1357.
Quinn MM (1991) Attachment between mothers and their down syndrome infants. Western
Journal of Nursing Research, 13, 382–396.
Seideman RY, Kleine PF (1995) A theory of transformed parenting: Parenting a child with
developmental delay/mental retardation. Nursing Research, 44, 38–44.
Soenens B, Duriez B, Vansteenkiste M, Goossens L (2007) The intergenerational trans-
mission of empathy-related responding in adolescence: The role of maternal support.
Personality and Social Psychology Bulletin, 33, 299–311.
Unger LS, Thumuluri LK (1997) Trait empathy and continuous helping: The case of vol-
untarism. Journal of Social behavior and Personality, 12, 785–800.
Wayment HA (2006) Attachment style, empathy, and helping following a collective loss: Ev-
idence from the September 11 terrorist attacks. Attachment and Human Development,
8, 1–9.
Winnicott DW (1965) The family and individual development. New York: Tavistock.
 Empathy and Prenatal Attachment 41

Wispe L (1986) The distinction between sympathy and empathy: to call forth a concept, a
word is needed. Journal of Personality and Social Psychology, 50, 314–321.

Note. A modified version of this paper was presented at the International Congress of the
International Society for Prenatal and Perinatal Psychology and Medicine and All-Russia
Congress of Russian Association for Pre- and Perinatal Development. Moscow, Russia,
May 2007.

Helen McK. Doan, Senior Scholar and Professor Emeritus, York University, Toronto, On-
tario, Canada
E-Mail hdoan@yorku.ca
Anona Zimerman, Doctoral Candidate and Therapist, York University and Surrey Place,
Toronto, Ontario, Canada
E-Mail anonaz@yorku.ca

View publication stats